Caregivers: Report Medicare Fraud and Receive Financial Reward

Medicare and Medicaid fraud have been a huge contributor to high costs of health care for seniors, with both improper reimbursements and unnecessary treatments and billings.  We are talking about billions of dollars in fraud.  The Department of Health and Human Services is now increasing the reward for anyone who reports fraud to as much as 15% of the amount recovered up to $9.9 million (and since billions of dollars in fraud has taken place, this maximum, unfortunately, is needed).  Here is their revised whistleblower reward program for those turning in companies and doctors who are fraudulently billing Medicare.
 
Medicare's new fraud alert reward has been modeled on an IRS program that has returned $2 billion in fraud penalties and unpaid taxes since 2003, the Health and Human Services Department says.
 
Senior caregivers who feel a senior is receiving medical treatment that is unnecessary or received medical doctor invoices for services that were not performed should call the Inspector General's hotline to report Medicare fraud.
 
The proposed rule would also strengthen certain provider enrollment provisions. One would allow HHS to deny enrollment of providers who are affiliated with an entity that has unpaid Medicare debt. It also would allow CMS to deny or revoke billing privileges for individuals with felony convictions, and revoke privileges for providers and suppliers who are abusing their billing privileges.
 
Under the proposed rule, HHS also would expand the ability of its Senior Medicare Patrol program to educate more Medicare beneficiaries about suspicious billing by providers that could be evidence of fraudulent activities. Total funding for all the 54 current SMP projects amounts to $7.3 million.
 
The Scooter Store has been a recent Medicare and Medicaid fraud spotlight for their laser focus on taking advantage of a high reimbursement for power wheelchairs for seniors - only they decided to give seniors cheaper scooters instead of high quality wheelchairs and even went so far as to have a network of medical doctors "approve" the senior's need for the power wheelchair.  
 
However, the federal government must also take some responsibility for The Scooter Store exploitation, simply because their juicy fees attracted The Scooter Store to play the fraud game. But of course the old reimbursements that were fat and juicy were due to lobbying by these groups.  The Wall Street Journal investigation also exposed that home health companies received a $2,000 bonus after the 10th R.N. home visit, and guess what?  The largest home health agencies always made sure they had 10 visits. This was not set-up to benefit seniors, but just another example of payments that make it into legislation due to strong lobbying.
 
Obama Care, as the new healthcare law has been labeled, does have some very positive aspects which include "accountability of care".  In addition, some Medicare reimbursements which were a bit unnecessary (i.e., would never survive in the private sector), were revamped.
 
Power wheelchairs payments were formerly paid in one lump sum by Medicare. Profits of thousands of dollars per wheelchair were pocketed by The Scooter Store immediately.  As of last year, though, this changed and a more reasonable rental fee was paid for the power wheelchairs.  Then The Scooter Store ran into cash flow issues and this, according to some former employees, stimulated even more aggressiveness to "get approval by a medical doctor" for a power wheelchair for a senior - going to 3 doctors or more and even coding doctors based on how difficult or easy it would be to get them to approve the wheelchair.
 
A whistleblower turned in The Scooter Store several years ago and this placed them under more scrutiny as they continued to push the envelope by selling power wheelchairs to individuals who did not really need one.  They even sent out direct mail promotions advertising they could obtain a "Free" wheelchair for seniors.  
 
Caregivers can help be the watchdog for Medicare fraud.  As senior caregivers are involved with day-to-day care, you have the inside view of all medical care and can quickly see when something seems unnecessary.  As more fraud is stopped, it is hope the senior care dollars will go towards actually paying for senior care.
 

Background Checks for Senior Caregivers: Frequently Asked Questions

Caregiver background checks are required by professional senior care companies.  The word "background check" causes confusion for many and because background checks are regulated under a federal law called the Fair Credit Reporting Act, or FCRA, it takes extra work to sift through the actual requirements and limitations of information shared in background checks.

Caregiverlist provides information on the Fair Credit Reporting Act, which has been updated over the years and received more additions to accommodate the terrorism act after September 11, 2001.  The Federal Trade Commission updates the FCRA and each state can also create their own laws governing background checks which may over-ride the FCRA.

What does this mean for senior caregivers?  First, it is important to understand that credit reports are separate from criminal background checks.  The following are frequently asked questions about caregiver background checks, along with answers.

Caregiver Background Check FAQ's

What information is included on an official caregiver background check?

Caregiver background checks first verify the individual "is who they say they are" by matching the person's name to their social security number and all addresses connected with that social security number.  This makes sure the caregiver is not an imposter as true criminals will many times simply steal someone else's identity in order to try to be hired.

Sex offender records are then checked.  Many times background check services will automatically tap into the national database for sex offenders at the same time the social security number match is validated.

After the social security number and name match are verified, then a criminal courthouse record check is performed in each of the counties where the caregiver has lived.

How many years back will criminal records show?  Just 7 years, as required by the federal law, but individual states may pass their own legislation which can allow review of background check information for more than 7 years if the employee will be working with seniors or children.  You may review the "by-state" background check laws to learn the look-back years in your state.

What information do criminal courthouse records show?

  • Arrests
  • Convictions
  • Motor-vehicle violations

Did you run a stop-sign and receive a traffic ticket?  This will show up on your criminal record, unless when you showed up in court the judge "dropped" the charge.  This is why if you have a traffic violation, from speeding tickets to running a redlight, you should always show up in court and try to negotiate for the charge to not show up on your record, and be reduced, if possible.

Theft and domestic violence charges will show up on your criminal record.  As caregivers will be going into a senior's home to assist them, it is very important to only hire a senior caregiver who has demonstrated responsible decision-making and has upheld high ethical and moral behavior.

Criminal courthouses sometimes charge an additional fee to access current records and you should always make sure any background check you are purchasing takes this into account.  Some courthouses do not submit criminal records to a national database daily and an "in-person" check is required which means you must have a real person go into the courthouse to pull the records.

What should caregivers do when applying for a job when they know there is a violation on their background check criminal record?

Be honest.  Also be aware of the 7-year look-back and find out if your state allows for a longer look-back period.  Remember, the federal law mandates that records of arrest, indictment, information, misdemeanor complaint, or conviction of a crime that, from the date of disposition, release, or parole, antedate the report by more than seven years.

How can a caregiver know what information is on their background check?

You may purchase a criminal background check and review the information.  If there is an error on your background check, you may contact the processing background check company to submit a request for review. This is called an "Applicant Dispute Reinvestigation" and will request supporting documentation to support your dispute with the background check results.

You may purchase a caregiver background check and remember that it is advised for individuals to check their own background check every few years, just to be sure there are no errors.  As we live in the highly "wired" era, one disadvantage of connected computerized information is that one typo can turn Susan into Susie and begin a chain of errors in information.  Caregiver job applicants can also ask their employer to share their background check results with them after they are hired.  Some employers will be willing to do this and others will not.  

 

 

 

 

 

 

 

 

Hilarity for Charity Raises Money for Alzheimer's Disease: April 25th in Los Angeles, California

Hilarity for Charity, presented by GIV Mobile, presents a variety show in Hollywood tomorrow to raise money for the fight against Alzheimer's Disease.  Actors Seth Rogen and Lauren Miller created Hilarity for Charity after being actively involved in the Alzheimer's community, in order to create awareness about the disease among the younger generation.

Part of the National Alzheimer's Association, money raised from this event will be directed towards assisting families struggling with caring for someone with Alzheimer's disease and assist with funding support groups and research for a cure.

Lauren Miller became involved in the fight against Alzheimer's disease after her Mother was diagnosed with early onset Alzheimer's disease at age 55.  She learned the challenges of caregiving and communicating how this disease impacts families.

Thursday's event will feature performances and appearances by Garfunkel & Oates, Sadie & The Blue Eyed Devils, Seth Rogen, Bo Burnham, John Mulaney and more.

Hilarity for Charity tickets may be purchased by buying a reserved table or an individual party crasher ticket at HilarityforCharity.com.  You also may make a donation to purchase a Hilarity for Charity Double Bracelet for $38.

Seniors who have been diagnosed with Alzheimer's disease will also need to plan ahead for long-term care needs and understand that Medicare does not pay for long-term care.  The Alzheimer's Association programs are helpful in assisting families to plan for senior care needs.  You can learn about nursing home daily costs nationwide on Caregiverlist.  As more caregivers are needed in the industry, remember that many times only companion caregivers are needed for those with memory loss and this can be fulfilling work for anyone with a caring personality.  Caregiverlist's Career Center connects caregivers with part-time and full-time senior caregiver jobs in their area (all with professional senior care companies).

Caregiver training also assists with learning caregiver skills in order to deliver quality care to seniors and you may also take an online caregiver training course.

And in the meantime, cheers to Hilarity for Charity to adding a laugh to the complexities of dealing with Alzheimer's Disease.

  

Boston Caregivers Keep on Caregiving

Boston, Massachusetts, experienced a week of loss and fear and transportation difficulties this past week after the bombing tragedy at the Boston Marathon.  Senior caregivers manage emotional and physical losses with senior clients each week and when a tragedy of the scale in Boston is added, caregiving becomes even more challenging.

Our hearts and prayers are with all of those in Boston this week and especially to senior caregivers who must overcome all challenges and still make it to their senior client's home each day.

Caregivers also will be needed for those injured in the Boston bombing and both family and professional caregivers will develop the skills necessary to deliver quality care.  Caregiver stress also is a very real experience and everyone must step in to support the caregivers, especially when care needs are not accounted for ahead of time.

Caregiverlist congratulates all of those who have dedicated their life's work to senior care and as the number of seniors in the U.S.A. will continue to grow, we invite more people to consider senior caregiving as a career.  Online caregiver trainin.g is available and senior care companies nationwide continue to hire from 3 to 6 new caregiver employees each week and you may apply for senior caregiver job near you on Caregiverlist.com.

Caregivers can join in the U.S.A.'s moment of silence in memory of the Boston Marathon bomb victims and the survivors, today at 2:50 p.m.

 

Texas City New Braunfels Sues The Scooter Store for Taking Job Creation Money

The Scooter Store, which will go down in history for successfully billing Medicare (and receiving payments) for power wheelchairs which were really cheaper scooters, was raided by the FBI and additional investigators earlier this year.  Now, the city where they are located, New Braunfels, Texas, has filed a lawsuit against the company for pocketing $3.4 million for job creation through a 2009 economic incentive program and then laying off thousands of workers.  The company claims they were impacted by a change in Medicare reimbursements (and tightening Medicare restrictions that helped end the company's practice of obtaining power wheelchair reimbursements from Medicare for cheaper scooters).  

New Braunfels, Texas, would now like $2.6 million of the economic stimulus money back for The Scooter Store's inability to maintain employment levels.  The Scooter Store has laid off 1,000+ employees and is keeping around 100+ employees for now in order to keep collecting the monthly payments on wheelchairs that are not paid off yet.

Caregiverlist originally wrote about The Scooter Store's fraudulent billing and misrepresentation of scooters for wheelchairs back in 2010 when the U.S. Government changed the category of reimbursements to be more clear on the status of a power wheelchair vs. a scooter which had 3 wheels and in no way can offer the mobility protection that a power wheelchair does to a senior who truly has mobility issues.

Power Wheelchairs for Seniors: Scooter Store's Pursuit of Medicare Benefit Opens Door to Fraud ($19 Million+)

Taxes should be less, not more, right? It seems like most people, as we approach April 15th, especially, agree with this.  It would also make sense that we would always want to save the government money on any programs, to help make our tax dollars go further.  But as we know, there are those who are looking to profit handsomely from any government program that will allow them to do so. The new healthcare law has been effective in cracking down on Medicare fraud and now it seems The Scooter Store could be the next company to go away, after selling seniors wheelchairs they could not use, did not want or need. So much for trying to save the government money, right? And they took advantage to the tune of $100 million in overcharges. Medicare reimbursements for power wheelchairs increased by more than 350% after The Scooter Store came along.  Scooter Store employees are now sharing stories of how the company color-coded doctors to indicate which doctors would approve of a "power wheelchair" for medical need, paid for by Medicare or Medicaid.

Medicare reimburses seniors for the purchase of a "power wheelchair" when a medical doctor has approved the need for the power wheelchair.  The reimbursement to medical supply companies was generous - so much so that some medical supply companies would call the home care agency I owned for 7 years and offer us $200 for each power wheelchair referral.  They received upwards of $2,000 for the sale of each power wheelchair from Medicare.

However, in 2011, Medicare finally changed the power wheelchair reimbursement to match the payment format for regular non-power wheelchairs which was a monthly rental fee.

A funny thing then happened at The Scooter Store when they were faced with "normal" profit margins.  Cash flow became tight, layoffs began and the push to gain medical doctor "approval" by going from doctor to doctor to doctor began. Former employees say they were urged to go to another more "friendly" doctor and to reach out to as many as 3 doctors if the first medical doctor declined approval for the wheelchairs.

This is why The Scooter Store would purchase television advertisements and announce to seniors that they could keep their wheelchair if it turns out they did not meet Medicare approval.  The Scooter Store scooted off to find wheelchair manufacturers who would go to China to produce wheelchairs for a very low cost and then of course they also helped facilitate the medical doctor "approval" of the wheelchairs.  A whistle-blower at the company took advantage of the government's whistle-blower protection program and shared that The Scooter Store sort of had their own medical doctor network who would approve of the need for the wheelchair. 

Here is the good and bad news.  If you truly do need a power wheelchair, for sure both you and your doctor know this.  It is simple.  You have difficulty with mobility and walking.  If a company needs to buy advertisements on television to convince you that you need a "scooter", which by the way, they can get for you for free from Medicare, well, there is probably "all kinds of wrong" with this, as my Grandmother would say.  A private company is trying to take advantage of a government program and profit at a much higher percentage than they would if truly operating as a private company with out a juicy government payment.  The fact that The Scooter Store could not operate a profitable company once Medicare reimbursements changed in 2011 speaks for itself.  Many, many other power wheelchair companies operate fairly and are profitable and were not impacted by the change in reimbursement from a lump sum to a monthly payment as it also is profitable reimbursement level.

The reality of needing a power wheelchair also comes with the fact that you will need assistance in customizing the wheelchair to fit your height, weight and arm and hand movement capabilities.  What if you also have arthritis?  This means that the medical equipment company fitting you for the wheelchair truly has some work to do to make sure the wheelchair is customized to fit both you and your home.  Then they also need to train you on how to properly use the wheelchair safely.  This is worth having Medicare pay them a fair price for their labor and is why the reimbursements may sound a bit generous to those who don't understand all the customization that is necessary.

A quality medical equipment company will also come to the home as much as is necessary in order to make sure the senior's wheelchair fits them properly and that all the necessary adjustments have been made.

Ordering a wheelchair that is really a "scooter" from a television ad takes away the customization.  In addition, promoting taking advantage of the power wheelchair benefit for use as a "scooter" just because you might want to get around a bit quicker is taking advantage of a program that was set-up to benefit those who truly cannot walk easily.  Used golf-carts might be a better solution for the senior who just wants a scooter to tool around the neighborhood in.

Medicare changed the definition of power wheelchairs precisely because of The Scooter Store.  Even if The Scooter Store's wheelchairs were high quality, it still cost taxpayers a huge amount of money by pocketing the profits from a program that was meant for seniors who truly needed a power wheelchair.

The Scooter Store settled with the government after the whistle-blower case for around $4 million and you may review this case with the Department of Justice here.

And now it seems The Scooter Store has been excluded from a list of 800 companies awarded contracts to supply medical equipment to Medicaid and Medicare beneficiaries beginning July 1, 2013.  In February, 2013, law enforcement officers raided The Scooter Store's Texas headquarters as part of an investigation in alleged fraud.  The Scooter Store founder, Doug Harrison, did step down from his role as CEO in 2011 and while many of us are trying to save the government money, he has in the past been a bit bummed out that the government was being more efficient about reimbursements, as you can see in this news release, when he complained that the government would no longer reimburse for wheelchairs at 6x's their wholesale price.............most retailers, by the way, are happy with 100% mark-ups.

Timothy Menke with the Office of the Inspector General says the investigation involves his agency, plus the Department of Justice, the FBI and the Texas attorney general's Medicaid fraud unit, according to The Associated Press.  

In 2012, an independent auditor determined that the company over-billed Medicare between $46.8 million and $87.7 million, the Express-News reported. The company agreed to repay $19.5 million after the Office of the Inspector General threatened to exclude it from federal health care programs.

We wonder if the U.S. Government will take one more step and hold accountable Mr. Harrison, the founder of The Scooter Store, as well.  Just as the Enron executives were held accountable for their actions.

The U.S. government had to create specific definitions about how a power wheelchair is not a scooter because of The Scooter Store trying to capitalize on the power wheelchair reimbursement from Medicare:

"By representing to physicians that their patients wanted and needed power wheelchairs, The SCOOTER Store obtained thousands of “Certificates of Medical Necessity” from physicians who did not know about the company’s fraudulent practices. The SCOOTER Store then billed government and private health care insurers for power wheelchairs, which were far more costly than power scooters, and collected millions of Medicare and Medicaid dollars.

The SCOOTER Store received $5,000 to $7,000 in reimbursement for each power wheelchair it sold, more than twice the amount for a scooter, which sold for around $1,500 to $2,000. Many beneficiaries had no idea what kind of equipment they were getting, until it was delivered by The SCOOTER Store.

The government’s lawsuit also alleged that The SCOOTER Store knowingly sold used power mobility equipment to beneficiaries and billed Medicare as if the equipment were new, in violation of Medicare regulations. In addition, the U.S. alleged that The SCOOTER Store charged Medicare millions for unnecessary power mobility accessories."

 Note:  The Scooter Store spent $1 million + lobbying Congress to maintain the previous Medicare reimbursements for wheelchairs.

 

Senior Care Planning: Living to be 105-Years-Old

Senior care costs vary widely, based on the care needs required for the senior and the living situation.  Does the senior live in a home that has been paid for fully and receive social security benefits?  If so, they can better pay privately for caregiving services.  If the senior does not own a home and requires full 24-hour caregiving services, they may qualify for Medicaid benefits, for very low-income seniors, and receive care in a Medicaid nursing home.  This is the safety net for all Americans currently.  However, as nursing home daily costs can vary from $100 to $400 per day, even the Medicaid senior care services are predicted to evolve as the number of seniors will quadruple in the coming decade.

Plan ahead for your own senior care needs to smooth the path for your family.  Remember, life expectancy of a child born in the U.S.A. today is 100 years.  Remember also that how you live your life today - eating right, exercising and finding a fulfilling life purpose, all impact the quality of your health as you age.  Nursing homes are often an extension of a hospital stay for seniors who may need rehabilitation and Caregiverlist's nursing home directory provides the daily cost of nursing homes nationwide.

Happy Birthday to this 105-year old senior who shared her photo with us celebrating her birthday at 105 with her great-granddaughter celebrating her 5-year-old brithday:  Birthday twins at 5 and 105!

Caregivers - let us know how old your senior clients are and if you can top age 105 - photos are welcome.  Enjoying sharing special life moments are another of advantage of working as a senior caregiver.

Certified Caregiver Training: Caregiver Certification Training Requirements

Certification for senior caregivers means a caregiver has been trained on the basic caregiving skills and passed a competency exam to verify they completed the course work.  Many skills must be mastered in order to deliver quality caregiving to a senior who may have challenges with mobility and memory, in addition to dealing with age-related illnesses.

Senior care companies nationwide, as part of the National Private Duty Association, now renamed the Home Care Association of America, came together to establish basic training skills for professional caregivers.  The state of Illinois adopted these basic training requirements as part of licensing requirements for senior home care agencies in 2008.  Most states do not have formal training requirements but suggest basic training skills be provided at orientation for new caregivers.  New Jersey and Florida do have training requirements for home health aides.

Family caregivers, along with professional caregivers who would like to formerly begin a caregiving career may now take these industry established basic caregiver training through an online course to be certified.  Senior care companies continue to seek high quality caregivers to fill ongoing part-time and full-time jobs and access Caregiverlist's proprietary hiring system to hire each week.  You may apply to a professional caregiving job on Caregiverlist and be considered for multiple openings in your area.

 

 

Nursing Home Costs Nationwide: Review Daily Costs of Nursing Homes

Senior care costs are an item that many of us do not plan ahead for - we just hope that it will never be a need.  However, the reality is that all of us should plan for needing senior care services for at least 2 years of our lives.  

Medicare, the health insurance program for all American seniors, does not pay for long-term care.  In the event a senior should "spend-down" all of their assets, they may qualify for Medicaid, a version of Medicare insurance for very low-income seniors with few assets.  Each state administers Medicaid benefits in conjunction with federal funding, which means the financial spend-down requirement varies in each state and you may view these financial requirements on Caregiverlist.

Medicaid financial qualification requirements in most states must be no more than $2,000 in assets for a single senior and $3,000 in assets for a couple.  There is an anti-spousal poverty provision that will allow one spouse to maintain more assets while the other spends down to qualify for Medicaid benefits.  This can especially be needed if one senior has memory loss or another age-related illness which requires years of caregiving services.

Nursing homes are often an extension of a hospital stay as Medicare will pay for rehabilitation services in a nursing home after a hospital stay.  However, Medicare does not pay for 100% of all the costs of a nursing home and only pays for the first 20 days of the daily fee (remember, some activities and hair care and other services cost extra) and then from days 21 to 148 the senior must pay $148 per day.  This means, in some instances, switching to one-on-one care in the home can be more cost effective.

Seniors should investigate nursing homes in their area before they need nursing home care, especially since there is a chance if a sudden medical condition such as a stroke or hip replacement, requires rehabilitation, the hospital may do a quick discharge to a nursing home in the area.  You may also receive information from licensed senior home care agencies.

Nursing home costs range from $100 to $400 or more per day.  You may review the daily costs of nursing homes nationwide in Caregiverlist's Nursing Home Directory to plan ahead for your senior care needs.

 

 

Caregiver Tales: Happy Easter!

Chicago caregivers may run into this bunny car, parked in downtown Chicago, this weekend.  Enjoy the holiday weekend, whatever your religion may be.  Sending wishes of Spring to all caregivers!  One of the best parts of being a caregiver is sharing in all the different ways of celebrating Springtime for Americans and a cute bunny springs eternal!  Remember that caregiver stress is real, so take time for a smile and if you would like to share your caregiving story with others, please do so, as we welcome more individuals to become professional senior caregivers and apply for a caregiving job as more caregivers are needed!

 

 

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